Pain is better but still hurts sometimes/a little

[BlueLightRN]

Is there a kind way to explain to patients that we can help their pain but not make it go away completely? And they can't take 5 times the ordered dose of pain meds because "that makes it so I don't hurt" meanwhile they are killing their liver? I mean, I want to yell at them (YOU HAVE BONE GRINDING ON BONE, YOU ARE GOING TO HAVE SOME PAIN NO MATTER WHAT WE DO! AND 20 VICODINS A DAY IS KILLING YOU MORON!)

Any advice is appreciated. I am not a pain management nurse (work in a clinic but see tons of people complaining of pain all the time) and we do lots of imaging, PT referrals, ortho referrals, etc, etc) but these people are driving me nuts.

[HappyWife77, BSN, RN]

Sounds like your dealing with addicts. We have to chart and do interventions along with pain meds that arent scheduled. Such as repositioning, massage, hydration, exercise, music therapy and the likes. That would drive me crazy too...and I bet they're not willing to try any thing except pain meds . Not sure what advice to give- maybe you guys could suggest treatment and recovery options.

[BlueLightRN]

We're outpatient, so I will not be doing any massage or exercises with these patients (especially since a lot of them are fairly gross, not to be mean but we see a lot of patients whom I don't touch without gloves, we're a very low-income clinic in a bad neighborhood.) I refer to treatment facilities and pain management specialists all the time. But they get kicked out of pain management or don't go or refuse treatment and then keep coming back to us begging for more drugs, even if they test positive for cocaine, marijuana, etc., etc they think it's totally okay to ask for percocets next time.

[aguerra]

Working with a population who wants to be completely pain free and want to medicate for every ache is really difficult. Working with patients who suffer from addiction or have addictive tendencies can be so tiring on your patience and your nerves. I work med surg and patients fully expect to be 100% pain free after surgery, and expect to take dilaudid IV all the way up until the time they roll out the door. I always include in my "my name is Alex and I'll be your nurse today" schpiel that you will not be completely pain free because of X,Y and Z but we will try this interventions to manage your pain. working outpatient or in a clinic is obviously a different setting, but many times by setting the tone of what the expectations are "your pain won't be a 9-10, but if we can get it to a 5 then thats ok" kinda thing. Advising the patient on what they can do at home; rest, ice, heat, alternating narcotics with non narcotic NSAIDs or even an herbal something or another, but the easiest way to say it, is just to say that you are trying to manage the pain, but more than likely it will not be 100% gone. Hope that helps!